Jordan, Glen S.

Jordan, Glen S. is an individual health care provider with primary practice located at 1340 Hal Greer Blvd , Huntington WV 25701-3804. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Jordan, Glen S. can be contacted via phone (304) 399-6727.

Contact Information

Primary practice address
1340 Hal Greer Blvd Huntington WV 25701-3804
Phone: (304) 399-6727
Fax: (304) 399-6726
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 01222 West Virginia

Profile Details

NPI number 1790885341
LBN Legal business name Jordan, Glen S.
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 24th, 2006
Last updated Apr 13th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790885341 NPPES
West Virginia Other P00711764 MEDICARE RR
West Virginia MEDICAID 0080124 MEDICARE RR
West Virginia MEDICAID 7100118540 MEDICARE RR
West Virginia MEDICAID 1790885341 MEDICARE RR

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